1811986631 NPI number — MS. CHARITE NICOLETTE RICKER MS,GCG

Table of content: MS. CHARITE NICOLETTE RICKER MS,GCG (NPI 1811986631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811986631 NPI number — MS. CHARITE NICOLETTE RICKER MS,GCG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICKER
Provider First Name:
CHARITE
Provider Middle Name:
NICOLETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS,GCG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811986631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 EASTLAKE AVE
Provider Second Line Business Mailing Address:
USCNORRIS CANCER HOSPITAL - GENETICS PROGRAM ROOM 1341
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90089-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-865-0911
Provider Business Mailing Address Fax Number:
323-865-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 EASTLAKE AVE
Provider Second Line Business Practice Location Address:
USCNORRIS CANCER HOSPITAL - GENETICS PROGRAM ROOM 1341
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-865-0911
Provider Business Practice Location Address Fax Number:
323-865-0933
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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